Bypass Surgery

What is coronary artery bypass surgery?

Coronary artery bypass surgery is a procedure in which a blockage in a coronary artery is bypassed to restore normal blood flow through the artery. Coronary arteries are blood vessels that carry oxygen and nutrients to the heart. The blockage can be bypassed with a new vessel made from part of one of your veins (usually from the leg) or another artery (usually in the chest).

When is it used?

Coronary artery bypass surgery may be necessary when arteries to your heart become narrowed or blocked.

If more than one artery is blocked, you may need more than one bypass. The location and degree of coronary artery blockages are determined before surgery with a procedure called heart catheterisation, or coronary angiogram.

How do I prepare for coronary bypass surgery?

Plan for your care and recovery after the operation. Allow for time to rest and try to find other people to help you with your day-to-day duties. Follow instructions provided by your doctor. Shower and wash your hair the night before the procedure. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You will be weighed the morning of the procedure. Later after the you will be weighed again to see if you are retaining water. To prevent infection, your legs, groin, and chest (if necessary) will be shaved.

You may be given a mild sedative to help you relax before the general anaesthetic is given. The anaesthetic will relax your muscles, keep you from feeling pain, and put you in a deep sleep.

Coronary artery bypass surgery is performed by a team of surgeons and lasts from 2 to 6 hours, depending on how many blood vessels need to be bypassed. One cut (incision) is made in the center of the chest at the breastbone to expose the heart. Another incision may be made in the leg to remove a vein for the new blood vessel that will bypass the blockage. (Otherwise, an artery in the chest, called the internal mammary artery, is used.) You are then connected to a heart-lung machine that supplies oxygen to your blood and circulates it back into your body while the surgery is performed.

If a piece of vein is used for the bypass, one end of the new blood vessel is sewn into the aorta (the main artery from the heart to the body). The other end is sewn into the area below the blockage in the coronary artery. If the mammary artery is used, the lower end of the mammary artery is cut and reattached to the coronary artery beyond the blockage. The blood then uses the new vessel as a detour to bypass the blockage before returning to its normal path.

When the surgery is finished, you are disconnected from the heart-lung machine, your breastbone is closed with wire, and your chest is closed with stitches or staples.

What happens after the procedure?

After surgery, you are placed in an intensive care unit (ICU) for several days for observation and monitoring. A constant electrocardiogram (ECG) monitor will record the rhythm of your heart. You will receive respiratory therapy to prevent any complications in your lungs, such as a collapsed lung, infection, or pneumonia. A nurse or therapist will give you a breathing treatment every few hours. It is extremely important to cooperate and ask for pain medication if you need it.

Therapy may include:

a.. deep breathing exercises
b.. coughing while holding a pillow against your chest to protect your breastbone
c.. chest percussion, which is a gentle slapping on the back to help loosen lung secretions that may have accumulated after surgery
d.. moving your legs to reduce the chance of blood clots.

While in the ICU, you may have the following tubes in your body to help in recovery

.. a breathing tube in your mouth that goes into your lungs and is connected to a ventilator to help you breathe
b.. a tube through your nose and down to your stomach to drain out natural fluids that may cause discomfort when you are not eating
c.. a catheter to empty your bladder
d.. intravenous (IV) tubes in your arms or neck for fluids, nutrition, and medications
e.. chest tubes  to drain blood from your chest cavity and to help detect any excessive bleeding in your chest
f.. an arterial line in your wrist to measure the pressure of the blood flowing through your arteries.

Sometime during the first 1 to 3 days after surgery, the tubes are removed and you are moved to an intermediate care unit. You will stay in this unit until you are ready to leave the hospital. You will have physical therapy, which includes walking around the hospital and other strengthening activities. You will learn how to move your upper arms without hurting your breastbone, and you will receive more respiratory therapy. You will be told about specific foods to avoid when you get home, such as foods high in fat, cholesterol, and sodium. Occupational therapy will help you learn how to take it easy while doing daily activities.

What are the risks associated with this procedure?

a.. Depending on your age and the condition of your heart, there is about a 2% to 10% risk of death from this operation.
b.. There are some risks when you have general anaesthesia. Discuss these risks with your doctor.
c.. There is a risk of infection or bleeding from this procedure.
d.. A bypassed vessel may become blocked again, which might require another heart catheterisation and surgery.
e.. There is a risk of stroke during the operation.

How can I take care of myself?

Follow the full treatment prescribed by your doctor, including all medications. In addition:

a.. Get plenty of rest.
b.. Plan at least two rest periods during the day (more if you still are tired).
c.. Enjoy the support and visits of family and friends, but keep visits short and allow yourself time to rest.
d.. Learn deep breathing and relaxation techniques.
e.. Talk about your feelings.
f.. Stop smoking.
g.. Lose weight slowly if you are overweight.
h.. Follow a healthy, well-balanced diet that is low in salt, saturated fats, and cholesterol.
i.. Weigh yourself every morning to help detect a water retention problem.
j.. Develop a regular exercise program prescribed by your doctor.
k.. If you feel constipated, ask your doctor for a stool softener or a fiber-based laxative. (Constipation is a common problem after having anaesthesia and being physically inactive.)
l.. Wear support hose to prevent swelling and circulatory problems in your legs. Putting powder on your legs can help you pull hose on more easily. Smooth out any wrinkles to avoid pressure spots.

How can I prevent problems from occurring during recovery?

a.. Follow your doctor’s recommended schedule of activity after surgery.
b.. Have someone help you with your bath or shower if you feel dizzy. Consider using a waterproof chair in the shower for safety.
c.. Avoid extremely hot water in your shower, bath, or hot tub because it can affect your circulation and cause light-headedness.
d.. Initially, avoid lifting anything heavier than 5 to 10 pounds.
e.. Avoid mowing the lawn, mopping, vacuuming, driving, and any other activities that strain your upper arms and chest until you have recovered.
f.. Avoid driving and sexual intercourse until your doctor tells you it’s okay to resume these activities.
g.. Ask your doctor whether you can drink any alcoholic beverages. When should I call the doctor?

Call the doctor immediately if:

a.. You develop a fever.
b.. You become short of breath.
c.. You have worsening chest pain.

Call the doctor during office hours if:

a.. You have questions about the procedure or its result.
b.. You want to make another appointment.